逆行股骨交锁髓内钉固定术：计算机断层扫描血管造影显示，在近端前后位交锁期间，不存在预防小直径动脉血管损伤的相对安全区。
Retrograde femoral nailing: computed tomography angiogram demonstrates no relative safe zone for prevention of small diameter arterial vascular injury during proximal anteroposterior interlocking.
作者信息
Shuler Franklin D, Busam Matthew, Beimesch Claire F, Block John J
机构信息
Department of Orthopaedics, West Virginia University, Morgantown, West Virginia 26506-9196, USA.
出版信息
J Trauma. 2010 Nov;69(5):E42-5. doi: 10.1097/TA.0b013e3181ca0624.
BACKGROUND
Reported iatrogenic injury to the proximal femoral vascular structures is rare after retrograde femoral nailing. Previous cadaveric dissections have recommended placement of proximal interlocking screws above the level of the lesser trochanter.
METHODS
This study is designed to define the arterial vascular anatomy anterior to the proximal medullary canal of the femur, which could be damaged with the placement of anteroposterior (AP) proximal interlocking screws.
RESULTS
Computed tomography angiograms of the structures anterior to the proximal femur demonstrate the presence of arterial branches >2 mm diameter in 100% of study patients at or above the level of the lesser trochanter.
CONCLUSIONS
No true safe zone corridor exists anteriorly for placement of AP interlocking screws in this region. Surgical technique modifications are suggested to minimize the potential risks of iatrogenic arterial injury during retrograde femoral nail AP proximal interlocking.
背景
逆行股骨交锁髓内钉固定术后医源性损伤股骨近端血管结构的报道较为罕见。既往尸体解剖研究建议将近端交锁螺钉置于小转子水平以上。
方法
本研究旨在明确股骨近端髓腔前方可能因前后位（AP）近端交锁螺钉置入而受损的动脉血管解剖结构。
结果
股骨近端前方结构的计算机断层血管造影显示，在小转子水平及以上，100%的研究患者存在直径>2mm的动脉分支。
结论
该区域不存在用于置入AP交锁螺钉的真正安全区通道。建议对手术技术进行改进，以尽量减少逆行股骨交锁髓内钉AP近端交锁时医源性动脉损伤的潜在风险。
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